The regeneration of cartilage and osteochondral defects remains one of the most challenging clinical problems in orthopedic surgery. Currently, tissue-engineering techniques based on the delivery of appropriate growth factors and mesenchymal stem cells (MSCs) in hydrogel scaffolds are considered as the most promising therapeutic strategy for osteochondral defects regeneration. In this study, we fabricated a heparin-conjugated fibrin (HCF) hydrogel with synovium-derived mesenchymal stem cells (SDMSCs), transforming growth factor-β1 (TGF-β1) and bone morphogenetic protein-4 (BMP-4) to repair osteochondral defects in a rabbit model. An in vitro study showed that HCF hydrogel exhibited good biocompatibility, a slow degradation rate and sustained release of TGF-β1 and BMP-4 over 4 weeks. Macroscopic and histological evaluations revealed that implantation of HCF hydrogel with SDMSCs, TGF-β1 and BMP-4 significantly enhanced the regeneration of hyaline cartilage and the subchondral bone plate in osteochondral defects within 12 weeks compared to hydrogels with SDMSCs or growth factors alone. Thus, these data suggest that combined delivery of SDMSCs with TGF-β1 and BMP-4 in HCF hydrogel may synergistically enhance the therapeutic efficacy of osteochondral defect repair of the knee joints.

The purpose of this study was to evaluate the safety of an injectable heparin-conjugated fibrin (HCF) hydrogel containing human synovium-derived mesenchymal stem cells (SDMSCs), TGF-β1, and BMP-4 after implantation into articular cartilage defect in patients with osteoarthritis (OA). The study included 15 OA patients with a mean age of 44.2±18.0 years. The median articular cartilage defect size was 4.9±2.0 cm. HCF hydrogel, containing SDMSCs and growth factors (TGF-β1 and BMP-4), was implanted into the cartilage defect using DUPLOJECT two-syringe device connected with the DUPLOTIP dual lumen cannula. Clinical and radiological outcomes were evaluated with VAS, WOMAC, KOOS, and MOCART. The clinical study results showed that implantation of HCF hydrogel with autologous SDMSCs, TGF-β1, and BMP-4 appeared to be safe and did not show severe adverse events in OA patients. The assessment of clinical outcomes after 6 months showed improvement in VAS, WOMAC, and KOOS scores in all patients. The MOCART evaluation demonstrated an enhancement of cartilage tissue repair in 73.3% of OA patients at 6 months after surgery. Thus, implantation of HCF hydrogel with SDMSCs, TGF-β1, and BMP-4 was safe and demonstrated signs of improvement in articular cartilage repair. The evaluation of the long-term safety and therapeutic efficacy of HCF hydrogel is required in a further clinical study using a larger number of OA patients.

The formation of anterior cruciate ligament cysts is one of the rare non-traumatic forms of knee joint lesions with unexplored etiopathogenesis. The formation of cysts of the anterior cruciate ligament is characteristic of younger people. The disease can be asymptomatic, being detected by chance during magnetic resonance imaging of the knee joint, in the case of a symptomatic course of the disease, the main complaints are chronic nonspecific pain, limitation of terminal flexion and extension of the joint, rarely mechanical symptoms. Magnetic resonance imaging is the method of choice for diagnosing these pathological conditions of the knee joint. The arthroscopic aid allows you to successfully combat this condition, while in the absence of a threat to the stability of the joint, debridement of the joint is performed, and if the stability of the joint is threatened, the issue of reconstruction of the anterior cruciate ligament is considered.

Untreated injuries to the Achilles tendon can lead to proximal retraction of the muscle-tendon fragment, increasing the likelihood of unsatisfactory results. The use of the long flexor tendon of the first toe is a well-proven method of treatment of this pathology, traditionally performed openly, by dissecting and exposing the soft tissues. We presented a clinical case of a patient with an Achilles tendon injury. In this article, we decided to share with the possibility of performing endoscopic transposition of the long flexor of the first toe in patients at risk of skin complications. Keywords: Achilles tendon, Flexor Halluces Longus, Endoscopic transposition, Case report, Kazakhstan

The article describes a clinical case of a patient with Achilles tendon defect with grafts from semitendinosus and gracilis muscles. The patient underwent an intervention to restore the function of the Achilles tendon by filling its defect with an autograft from the semitendinosus and gracilis muscles of the thigh. Our proposed technique for the restoration of the Achilles tendon defect is unique. This technique requires further study and, in a favorable treatment outcome, introduce this technique for widespread use.